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Background and Purpose <p>The relationship between quantitative hematoma characteristics and clinical prognosis in patients with intracerebral hemorrhage (ICH) undergoing minimally invasive surgery (MIS) remains unclear. This study aims to investigate the association between mean hematoma density and in-hospital mortality in patients with ICH undergoing MIS, and to explore whether hematoma evacuation efficacy mediates this relationship.</p> Methods <p>We analyzed a retrospective dataset collected from January 2019 and February 2023 at Beijing Tiantan Hospital. Hematomas on noncontrast computed tomography (NCCT) were manually segmented by two independent neurologists. Hematoma evacuation efficacy was evaluated by end-of-treatment (EOT) volume and hematoma clearance. The associations between mean hematoma density and pre-MIS NCCT, hematoma evacuation efficacy, and in-hospital mortality were respectively analyzed using multivariable regression analysis, adjusting for key covariates including age, sex, and disease severity. Mediation effects among mean hematoma density, hematoma evacuation efficacy, and in-hospital mortality were also examined.</p> Results <p>A total of 207 patients with ICH undergoing MIS were finally enrolled. Higher mean hematoma density was significantly associated with poor hematoma evacuation efficacy [EOT volume: adjusted β 0.88, 95% confidence interval (CI) 0.37–1.38, <i>p</i> &lt; 0.001; hematoma clearance: adjusted β −0.01, 95% CI −0.02 to 0, <i>p</i>&#xa0;= 0.005]. Poor hematoma evacuation efficacy was associated with increased odds of in-hospital mortality (EOT volume: adjusted OR 1.07, 95% CI 1.04–1.12, <i>p</i>&#xa0;&lt; 0.001; hematoma clearance: adjusted OR 0.03, 95% CI 0–0.20, <i>p</i>&#xa0;&lt; 0.001). The mean hematoma density was significantly associated with in-hospital mortality (adjusted OR 1.16, 95% CI 1.03–1.31, <i>p</i>&#xa0;= 0.026). Significant indirect effects were observed between mean hematoma density and in-hospital mortality, mediated by hematoma evacuation efficacy. The proportion of indirect effect mediated via EOT volume or hematoma clearance was estimated to be 46% and 37%, respectively.</p> Conclusions <p>Hematoma evacuation efficacy may mediate the association between mean hematoma density and in-hospital mortality in patients with ICH undergoing MIS.</p>

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Associations between Hematoma Density, Hematoma Evacuation Efficacy, and In-Hospital Mortality in Patients Undergoing Minimally Invasive Surgery after Intracerebral Hemorrhage

  • 期刊论文

  • 发表日期：

    2026年3月12日

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  • Lei Wu,
  • Zeqiang Ji,
  • Kaijiang Kang,
  • Wanxing Ye,
  • Sijia Li,
  • Xingquan Zhao

摘要

Background and Purpose

The relationship between quantitative hematoma characteristics and clinical prognosis in patients with intracerebral hemorrhage (ICH) undergoing minimally invasive surgery (MIS) remains unclear. This study aims to investigate the association between mean hematoma density and in-hospital mortality in patients with ICH undergoing MIS, and to explore whether hematoma evacuation efficacy mediates this relationship.

Methods

We analyzed a retrospective dataset collected from January 2019 and February 2023 at Beijing Tiantan Hospital. Hematomas on noncontrast computed tomography (NCCT) were manually segmented by two independent neurologists. Hematoma evacuation efficacy was evaluated by end-of-treatment (EOT) volume and hematoma clearance. The associations between mean hematoma density and pre-MIS NCCT, hematoma evacuation efficacy, and in-hospital mortality were respectively analyzed using multivariable regression analysis, adjusting for key covariates including age, sex, and disease severity. Mediation effects among mean hematoma density, hematoma evacuation efficacy, and in-hospital mortality were also examined.

Results

A total of 207 patients with ICH undergoing MIS were finally enrolled. Higher mean hematoma density was significantly associated with poor hematoma evacuation efficacy [EOT volume: adjusted β 0.88, 95% confidence interval (CI) 0.37–1.38, p < 0.001; hematoma clearance: adjusted β −0.01, 95% CI −0.02 to 0, p = 0.005]. Poor hematoma evacuation efficacy was associated with increased odds of in-hospital mortality (EOT volume: adjusted OR 1.07, 95% CI 1.04–1.12, p < 0.001; hematoma clearance: adjusted OR 0.03, 95% CI 0–0.20, p < 0.001). The mean hematoma density was significantly associated with in-hospital mortality (adjusted OR 1.16, 95% CI 1.03–1.31, p = 0.026). Significant indirect effects were observed between mean hematoma density and in-hospital mortality, mediated by hematoma evacuation efficacy. The proportion of indirect effect mediated via EOT volume or hematoma clearance was estimated to be 46% and 37%, respectively.

Conclusions

Hematoma evacuation efficacy may mediate the association between mean hematoma density and in-hospital mortality in patients with ICH undergoing MIS.